Investigation of a Blood transfusion Reaction

Donor- Recipient compatibility for ABO taking account of clinically significant allo-antibodies in the recipient.
          The mechanism of haemolysis depends on the class of the antibody and its availability of fix complement.
Haemolytic transfusion Reaction(HTR)
1. Acute
  • Intravascular
  • Extra Vaskular
2. Delayed - Mainly extravascular
  • Acute : Intravascular Haemolysis : It is potentially fatal and is usually due to ABO in compatibility.
Serological Investigation:
Specimens required.
1. Per transfusion serum and red cells of the patient.
2. Post trans serum and red cells of the patient.
3. Urine from the patient for the first 24 hrs of the reaction. This will be dark and presence of                  hemoglobin in the case of intra vascular haemolysis.
Serological Test:
1. Confirm the ABO and RH groups of the patient's pre and post transfusion samples and the donor         units.
2. Perform DAt on the patient's pre and post transfusion washed red cells.
3. Repeat cross match test of donor's red cells with patient serum using pre and post transfusion              samples.
4. Screen the donor plasma and the patient's pre and post transfusion serum samples for unexpected        antibodies.
5. If the donor was group 'O' and the patient 'A' and 'B' then titre of anti-A and anti B.
Haemotological Test:
1. Blood count: including platelets and Reticulocyte count.
2. Blood Film: Spherocytosis, red cell agglutinate.
3. Coagulation screen: FDP, Fibrinogen.
Bacteriological Test:
- Culture/Sensitivity
- Gram stain.
Bio Chemical Test:
A. The patient's post transfusion serum should be inspected Haemolysis.
- Free Haemoglobin
- Billirubin
- Urea
- Creatinine
- Na and K
B. Acute Extravascular Haemolysis:
      It is a feature of antibodies that do not cause complement lysis.eg.Anti-D.It is less severe                    haemolytic reaction.
C. Delayed Haemolytic transfusion Reactions:
     Delayed may occur in patient allo- immunised by previous pregnancy or transfusion.






       

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